# Neuro-Oracle: A Trajectory-Aware Agentic RAG Framework for Interpretable Epilepsy Surgical Prognosis

arXiv: https://arxiv.org/abs/2604.14216 · HTML: https://mlsanity.com/paper/2604.14216/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Builds on 15 of its 34 references that are in the map.
- First posted on arXiv 10 Apr 2026.

## Builds on (most cited first, 15 of 15)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [A Simple Framework for Contrastive Learning of Visual Representations](https://mlsanity.com/paper/2002.05709/) (2020)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Momentum Contrast for Unsupervised Visual Representation Learning](https://mlsanity.com/paper/1911.05722/) (2019)
- [Supervised Contrastive Learning](https://mlsanity.com/paper/2004.11362/) (2020)
- [Billion-scale similarity search with GPUs](https://mlsanity.com/paper/1702.08734/) (2017)
- [A Survey on Deep Learning in Medical Image Analysis](https://mlsanity.com/paper/1702.05747/) (2017)
- [UNETR: Transformers for 3D Medical Image Segmentation](https://mlsanity.com/paper/2103.10504/) (2021)
- [MONAI: An open-source framework for deep learning in healthcare](https://mlsanity.com/paper/2211.02701/) (2022)
- [MMed-RAG: Versatile Multimodal RAG System for Medical Vision Language Models](https://mlsanity.com/paper/2410.13085/) (2024)

## Built on by (most cited first, 2 of 2)

- [Algorithmic Authority and the Clinical Standard of Care](https://mlsanity.com/paper/2606.00044/) (2026)
- [Volumetric Radiology AI in the Era of Multimodal Large Language Models](https://mlsanity.com/paper/2608.20549/) (2026)

## Abstract (arXiv)

Predicting post-surgical seizure outcomes in pharmacoresistant epilepsy is a clinical challenge. Conventional deep-learning approaches operate on static, single-timepoint pre-operative scans, omitting longitudinal morphological changes. We propose Neuro-Oracle, a three-stage framework that: (i) distils pre-to-post-operative MRI changes into a compact 512-dimensional trajectory vector using a 3D Siamese contrastive encoder; (ii) retrieves historically similar surgical trajectories from a population archive via nearest-neighbour search; and (iii) synthesises a natural-language prognosis grounded in the retrieved evidence using a quantized Llama-3-8B reasoning agent. Evaluations are conducted on the public EPISURG dataset (N=268 longitudinally paired cases) using five-fold stratified cross-validation. Since ground-truth seizure-freedom scores are unavailable, we utilize a clinical proxy label based on the resection type. We acknowledge that the network representations may potentially learn the anatomical features of the resection cavities (i.e., temporal versus non-temporal locations) rather than true prognostic morphometry. Our current evaluation thus serves mainly as a proof-of-concept for the trajectory-aware retrieval architecture. Trajectory-based classifiers achieve AUC values between 0.834 and 0.905, compared with 0.793 for a single-timepoint ResNet-50 baseline. The Neuro-Oracle agent (M5) matches the AUC of purely discriminative trajectory classifiers (0.867) while producing structured justifications with zero observed hallucinations under our audit protocol. A Siamese Diversity Ensemble (M6) of trajectory-space classifiers attains an AUC of 0.905 without language-model overhead.